Critical Care Newsline — August 21, 2008

Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by AACN. Every week, our expert clinical practice staff reviews hundreds of journals and Web sites, choosing only the most pertinent information for Critical Care Newsline. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and Web sites on a variety of topics to keep you informed on issues that affect nurses and the nursing profession.

As a critical care nurse you know that thousands of people die every year waiting for organ donations. At the same time, you provide care for patients that may be potential organ donors. In scanning the journals this week, AACN's Clinical Practice department found the following articles that provide information about the topic.

The August 14 issue of the New England Journal of Medicine explores the issue of organ donation after cardiac death. In the journal’s Perspective Roundtable, researchers weigh in on the changing assumptions about when death occurs and how to decide which patients are suitable organ donors. To view the roundtable discussion click here or read the following related articles.

1. EVIDENCE Boundaries of Organ Donation after Cardiac Death (Free Full Text)
Organ donation after cardiac death is now part of the mainstream in healthcare; as a result, researchers have begun to design innovative protocols to improve transplants and expand the donor pool. In a recent study published in the New England Journal of Medicine, researchers reported success with a protocol to donate infant hearts after cardiac death.

2. EVIDENCE Donating Hearts after Cardiac Death — Reversing the Irreversible (Free Full Text)
In this article, researchers report findings that may seem to address the shortage of hearts for pediatric transplantation. Successful transplantation was performed in three infants with the use of hearts from other infants who had been pronounced dead according to cardiac criteria. According to the study’s researchers, these results appear to open the door to heart transplantation after cardiac death.

3. EVIDENCE The Dead Donor Rule and Organ Transplantation (Free Full Text)
Authors of this study report that reliance on the dead donor rule has greater potential to undermine trust in the transplantation enterprise than to preserve it. At worst, “reliance suggests that the medical profession has been gerrymandering the definition of death to carefully conform with conditions that are most favorable for transplantation. At best, the rule has provided misleading ethical cover that cannot withstand careful scrutiny”, the researchers noted. The authors suggest a better approach to procuring vital organs while protecting vulnerable patients against abuse: to emphasize the importance of obtaining valid informed consent for organ donation from patients or surrogates before withdrawing life-sustaining treatment in patients with devastating and irreversible neurologic injury.

4. EVIDENCE Nurses' Perceptions of Error Communication and Reporting in the Intensive Care Unit (Abstract)
Medical errors distress nurses who are conflicted about disclosing, discussing, and reporting them. Lack of feedback from administration about reported errors reinforces the nurses’ sense that reporting is not useful. The authors of this study report that recognizing the barriers to learning about safety from reporting and the need for visibility in communicating lessons from errors is essential as hospitals strive for safe patient care.

To learn more about medical errors and patient safety, check out the Agency for Healthcare Research and Quality’s extensive online resources on this topic.

5. EVIDENCE Tall Man Letters: When Drugs Have Similar Names (Free Full Text)
This article reports the results of an Institute of Safe Medical Practices survey on "tall man lettering," the use of uppercase letters as a means to differentiate drugs with look-alike names, to help prevent medication errors. Tall man letters are uppercase letters that are used within a drug name to highlight its primary dissimilarities with look-alike drug names. Several studies have shown that: 1) highlighting sections of words using tall man lettering can make similar drug names easier to distinguish and 2) fewer errors are made when tall man letters are used to differentiate products with look-alike names. The Joint Commission and other safety-conscious organizations such as the National Association of Boards of Pharmacy have promoted the use of tall man letters as a way to reduce confusion between similar drug names.

6. EVIDENCE Disruptive Behaviors and Communication Defects Impact Patient Safety (Abstract)
A recent survey was conducted to assess the significance of disruptive behaviors and their effect on communication and collaboration and impact on patient care. The results from the survey show that disruptive behaviors lead to potentially preventable adverse events, errors, compromises in safety and quality, and patient mortality. Strategies to address disruptive behaviors should (1) prevent disruptive events from occurring; (2) deal with events in real time to prevent staff or patient harm; and (3) initiate post-event review, actions and follow-up. Twelve recommendations—including recognition and awareness, policies and procedures, incident reporting, education and training, communication tools, discussion forums and intervention strategies—suggest what hospitals and other organizations can do now to address disruptive behaviors.

AACN is committed to the creation and maintenance of work environments that are free from intimidation, threats and abuse and calls for all institutions to implement enforceable policies and programs to prevent and eliminate abusive, disrespectful and non-collaborative behaviors in the workplace. To read more about AACN’s position on this issue, click here.

7. CALL TO ACTION Research and Creative Solutions and Chapter Poster Abstracts Sought for NTI 2009
Showcase your best practices and share what you’ve learned with your colleagues by submitting poster abstracts for presentation at NTI 2009 in New Orleans. The deadline is Oct.15, 2008. You do not have to be an AACN member to submit an abstract.

8. EVENT Half-day PCNA-AACN Regional CE Programs to Improve Cardiovascular Disease Outcomes
Regional programs to improve cardiovascular disease outcomes will be held nationwide during the next three months. The events, hosted by the Preventive Cardiovascular Nurses Association and AACN, kicks off in the San Francisco Bay area Sept 6. Sessions focus on treatment pathways and breakthroughs for ACS and MI patients; point-of-care testing to improve outcomes for patients at risk of heart failure, dyslipidemia and coagulation disorders; and information about the residual risk of HDL and triglycerides. The programs are free for AACN members. Online pre-registration is required. Click here for the complete list of locations.

9. Clinical Practice Resources

PATIENT SAFETY ISSUES
Boston Scientific NexStent Monorail-Class I Recall: the Tip of the Stent May Detach From the Delivery System During Carotid Artery Stenting Procedures

Adverse Injection Site Reactions in Patients Given Injections of Vivitrol (Naltrexone)

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